Provider Demographics
NPI:1912003997
Name:UPHUES, MICHAEL R (DO)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:UPHUES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 4TH AVE N
Mailing Address - Street 2:
Mailing Address - City:WOLF POINT
Mailing Address - State:MT
Mailing Address - Zip Code:59201-1215
Mailing Address - Country:US
Mailing Address - Phone:406-653-1641
Mailing Address - Fax:
Practice Address - Street 1:901 4TH AVE N
Practice Address - Street 2:
Practice Address - City:WOLF POINT
Practice Address - State:MT
Practice Address - Zip Code:59201-1215
Practice Address - Country:US
Practice Address - Phone:406-653-1641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10187207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT2210068Medicaid
MTG72402Medicare UPIN
MT8HZ85DMedicare PIN
MT2210068Medicaid